Can we accurately measure the concentration of clinically relevant vitamin D metabolites in the circulation? The problems and their consequences

Wzrost zainteresowania oznaczeniami stężenia witaminy D przyczynił się do opracowania w ostatnich latach nowych testów immunochemicznych (manualnych oraz do automatycznych analizatorów). Do laboratoriów diagnostycznych wprowadza się również techniki dotychczas niestosowane w rutynowych oznaczeniach witaminy D, takie jak HPLC (wysokosprawna chromatografia cieczowa) oraz LC-MS/MS (tandemowa spektrometria mas sprzężona z wysokosprawną chromatografią cieczową). W związku z różnorodnością testów i metod pojawia się pytanie o ich wiarygodność. W niniejszej pracy przeglądowej opisano występujące w krwiobiegu metabolity witaminy D, przedstawiamy zalety i wady stosowanych metod oznaczania ich stężenia oraz omawiamy czynniki mające wpływ na wiarygodność wyników tych oznaczeń. (Endokrynol Pol 2013; 64 (3): 238–245)Increased interest in vitamin D measurements in clinical studies has contributed to the development in recent years of several new immunochemical assays (manual and for automatic analyzers). New methods, including HPLC (high performance liquid chromatography), and LC-MS/MS (liquid chromatography coupled with tandem mass spectrometry) have also been introduced into routine diagnostic laboratories. Because of the variety of assays and methods used, the question arises which one is the most accurate for the measurement of vitamin D metabolites concentration. In this review, we summarise the advantages and disadvantages of these methods, describe the complexity of vitamin D metabolites pattern in the circulation, and discuss the problem of accurate measuring its concentration. (Endokrynol Pol 2013; 64 (3): 238–245

Gruźlica kręgosłupa : obraz radiologiczny : opis przypadku

Background: Skeletal tuberculosis constitutes 1-3% of all cases of tuberculosis and involves the spine in up to 50% of cases, most commonly the thoracolumbar spine. The purpose of this article is to review the case of a 47-year-old man who complained of back pain, weakness of muscles and weight loss. Case report: He was examined with conventional anteriorposterior and lateral X-rays of thoracic spine, computed tomography (CT) and magnetic resonance imaging. Radiological imaging suggested tubercolosis of the spine. The authors present the imaging procedures applied to diagnose this case. Conventional radiography was used as the first basic examination. Computed tomography (CT) and magnetic resonance imaging (MR) were used as complementary methods. Conclusions: The final diagnosis was based on a biopsy of the bone. The definite diagnosis is required to adequate treatment. In some cases surgical treatment is used

Giant intracranial arteriovenous malformation : a case report

Intracranial arteriovenous malformations (AVMs) occur in 0.5-1% of the population [1]. An arteriovenous malformation is a tangled cluster of vessels, in which arteries connect directly to veins with no intervening capillary bed. Because an intracranial hemorrhage, or, rarely, a seizure are the first clinical symptoms of AVMs, they are the most dangerous congenital vascular malformations [1, 3, 4, 5]. We report a case of a 37-year-old woman with a giant intracranial arteriovenous malformation, who complained of headache attacks. The lesion was diagnosed in computed tomography and computed angiotomography of the head. The first imaging study in patients with suspected AVM is usually CT or angio-CT. These studies are good for depicting an AVM, and they are relatively noninvasive. However, angiography used for the diagnosis and planned treatment is invasive. The authors present also the options for therapy

Czy umiemy wiarygodnie mierzyć stężenia klinicznie ważnych metabolitów witaminy D? Problemy i ich konsekwencje

Wzrost zainteresowania oznaczeniami stężenia witaminy D przyczynił się do opracowania w ostatnich latach nowych testów immunochemicznych (manualnych oraz do automatycznych analizatorów). Do laboratoriów diagnostycznych wprowadza się również techniki dotychczas niestosowane w rutynowych oznaczeniach witaminy D, takie jak HPLC (wysokosprawna chromatografia cieczowa) oraz LC-MS/MS (tandemowa spektrometria mas sprzężona z wysokosprawną chromatografią cieczową). W związku z różnorodnością testów i metod pojawia się pytanie o ich wiarygodność. W niniejszej pracy przeglądowej opisano występujące w krwiobiegu metabolity witaminy D, przedstawiono zalety i wady stosowanych metod oznaczania ich stężenia oraz omówiono czynniki mające wpływ na wiarygodność wyników tych oznaczeń

Circulating sCD138 and Some Angiogenesis-Involved Cytokines Help to Anticipate the Disease Progression of Early-Stage B-Cell Chronic Lymphocytic Leukemia

Syndecan-1 (CD138) is a transmembrane heparin sulfate proteoglycan expressed on distinct stages of differentiation of B-lymphoid cells. Its prognostic value in B-cell chronic lymphocytic leukemia (B-CLL) has not been evaluated so far. The serum concentration of sCD138 and some angiogenesis-involved cytokines: vascular endothelial growth factor (VEGF), basis fibroblast growth factor (bFGF), and endostatin were studied in 52 previously untreated patients with B-CLL. We found that bFGF and sCD138 levels were significantly higher in B-CLL patients than in controls. In patients with sCD138 level or endostatin level below the median value the lymphocyte count was higher than in patients with serum level of those cytokines above the median value. In patients with progressive disease bFGF level was significantly higher and sCD138 level significantly lower than in patients with stable one. Moreover, high sCD138 level was associated with longer lymphocyte doubling-free survival, and, on the limit of statistical significance, a high endostatin level was associated with shorter progression-free survival. We conclude that serum sCD138 level is increased in early stage B-CLL patients and may have a positive prognostic value as to the dynamics of the disease

Total testosterone to dihydrotestosterone ratio assessed by LC-MS/MS predicts a worse metabolic profile not only in PCOS patients

Objectives: Total testosterone/dihydrotestosterone ratio (TT/DHT) was found to determine metabolic risk in polycystic ovary syndrome (PCOS). The aim of this study was to analyze whether (TT/DHT) may be helpful in predicting metabolic risk not only in PCOS patients but also in healthy women. Material and methods: Total testosterone (TT), dihydrotestosterone (DHT), androstendione and dehydroepiandrosterone sulphate (DHEA-S) were measured by LC-MS/MS in 36 women with PCOS and in 29 age-matched controls without clinical hyperandrogenism. In all participants, anthropometric data, lipids, adipose tissue percent (%fat), HOMA-IR were also assessed. Results: The studied groups were not different in terms of age, BMI, waist circumference, %fat and HOMA-IR. In the patients group, mean TT and androstendione levels were significantly higher as compared to controls (1.4 nmol/L vs. 1.0 nmol/L, P < 0.001) and (6.6 nmol/L vs. 4.9 nmol/L, P < 0.01), respectively. In the patients group, mean TT/DHT ratio was significantly higher compared to controls (3.6 vs. 2.7, P < 0.01) and correlated with BMI (r = 0.37, P < 0.05), waist circumference (r = 0.44, P < 0.01), %fat (r = 0.30, P < 0.05), as well as with insulin levels (r = 0.38, P < 0.05) and HOMA-IR (r = 0.44, P < 0.05). The association between TT/DHT ratio and unfavorable metabolic parameters was also seen in controls. Conclusion: Total testosterone/dihydrotestosterone ratio assessed by LC-MS/MS correlates with a worse metabolic profile not only in PCOS patients, but also in healthy women

Obraz radiologiczny dużego potworniaka śródpiersia przedniego

Background: Teratomas belong to germ cell tumors. They are frequently found in gonads, but appear as well in mediastinum and other locations. They are usually benign. Case report: We present a case of a 51-year-old male patient with big teratoma in the anterior mediastinum, which was diagnosed a long time ago. This lesion was found on Computed Tomography examination, surgically resected and histopathologically confirmed. Conclusions: CT findings of teratomas are characteristic enough to allow a diagnosis of high probability. Surgical resection is a sufficient treatment

Harmless disease or deadly danger? – Assessment of Upper Silesia inhabitants' level of knowledge regarding peptic ulcers

INTRODUCTION Peptic ulcers affect a large part of the general adult population. The associated risk factors and symptoms seem to be widely known. Nevertheless, deaths due to complications of undiagnosed or inappropriately treated peptic ulcers remain relatively frequent. The aim of this study was to assess the level of Upper Silesia inhabitants' knowledge of the disease. MATERIAL AND METHODS The survey was conducted among 203 randomly selected adult Upper Silesians. The questionnaire assessed the general knowledge about ulcers. The respondents were asked to indicate the definition, predisposing factors, direct causes and characteristic symptoms of the disease. They also had to choose the applicable diagnostic methods and therapies. RESULTS Only 7.9% of respondents defined peptic ulcers correctly. There were no statistically significant differences in the frequencies of correct answers between the group of sex, age, education level or place of living. Every seventh person claimed that the complications of peptic ulcers cannot lead to death. Helicobacter pylori infection was recognized as a main pathogenetic factor only by 42.9% of respondents. Instead, respondents chose inappropriate diet, chronic stress and alcohol abuse as the main causes of peptic ulcers. CONCLUSIONS Few respondents are able to identify the correct definition of a peptic ulcer. Less than half of the respondents recognize the direct contribution of Helicobacter pylori infection to gastric ulcer formation. The majority is aware of the risks posed by the complications of peptic ulcers.W S T Ę P Choroba wrzodowa dotyka znacznej części społeczeństwa, a czynniki ryzyka oraz objawy schorzenia wydają się powszechnie znane. Wciąż zdarzają się jednak zgony spowodowane powikłaniami choroby u pacjentów, którzy nie zostali zdiagnozowani lub nie poddali się terapii. Celem pracy była ocena poziomu wiedzy mieszkańców Śląska na temat tego schorzenia. M A T E R I A Ł I M E T O D Y Przeprowadzono badanie ankietowe wśród 203 przypadkowo wybranych, pełnoletnich mieszkańców Śląska. Kwestionariusz oceniał ogólną wiedzę na temat choroby wrzodowej. Badano umiejętność dopasowania prawidłowej definicji, wskazania czynników predysponujących, bezpośrednich przyczyn powstawania oraz charakterystycznych objawów schorzenia. Ankietowani byli również proszeni o wskazanie sposobów diagnostyki i terapii. WYNIKI Zaledwie 7,9% ankietowanych wskazało prawidłową definicję wrzodu trawiennego. Nie wykazano istotnej statystycznie różnicy między częstością udzielania prawidłowych odpowiedzi zależnie od płci, grupy wiekowej, wykształcenia lub miejsca zamieszkania. Co siódmy badany uznaje, że powikłania choroby wrzodowej nie mogą doprowadzić do śmierci. Zakażenie Helicobacter pylori (H. pylori) jest uważane za czynnik patogenetyczny schorzenia przez 42,9% ankietowanych, częściej wymieniane są natomiast: przewlekły stres, dieta i nadużywanie alkoholu. WNIOSKI Niewielki odsetek ankietowanych wskazuje prawidłową definicję wrzodu trawiennego. Mniej niż połowa respondentów dostrzega bezpośredni wpływ zakażenia H. pylori na powstawanie wrzodów żołądka. Większość ankietowanych zdaje sobie sprawę z ryzyka, jakie niosą ze sobą powikłania choroby wrzodowej